Investigating the Prevalence of Copper and Zinc Abnormalities in Patients Pre and Post Bariatric Surgery-an Australian Experience

Overview

Journal Obes Surg

Date 2023 Sep 29

PMID 37773088

Authors

Nazy Zarshenas

Linda C Tapsell

Marijka Batterham

Elizabeth P Neale

Michael L Talbot

Affiliations

Soon will be listed here.

Abstract

Introduction: Bariatric surgery predisposes patients to nutritional deficiencies. There are limited studies on zinc and copper abnormalities in this cohort.

Purpose: The aim of this study was to identify the prevalence of these abnormalities in a cohort of Australian bariatric patients. Inflammatory markers, adherence to multivitamin supplementation (MVS) and the presence of gastrointestinal (GI) symptoms were also investigated.

Material And Methods: Data was collected on all patients who attended a single clinic in Sydney, Australia, from August 2020 to August 2021.

Results: The study cohort consisted of 231 patients (76.2% female; mean pre-operative body mass index of 43.4 ± 7.1 kg/m), most of whom underwent sleeve gastrectomy (78.8%). Data were collected preoperatively and then at ≤ 6 months, 1 and > 2 years postoperatively. Prior to surgery, low levels of zinc (2.1%) and copper (0.7%) were rare, but elevated copper levels were common (16.7%) and potentially related to an elevated C-reactive protein (CRP) (47.7%). Following surgery at > 2 years, the mean total weight loss (TWL) was 33.5 ± 12.4. CRP levels improved over time. Post operatively, low zinc (2.7-3.6%) and copper (1.5%) levels were rare. Patients with low levels in zinc and copper were a higher-risk group and generally exhibited GI symptoms, despite taking MVS.

Conclusion: In the initial post-operative stages and with good adherence to MVS containing copper and zinc, abnormalities may not be a concern. Patients with GI symptoms appear to be at higher risk of abnormalities; increasing awareness, thorough screening, and more comprehensive supplementation are recommended.

References

Gletsu-Miller N, Broderius M, Frediani J, Zhao V, Griffith D, Davis Jr S . Incidence and prevalence of copper deficiency following roux-en-y gastric bypass surgery. Int J Obes (Lond). 2011; 36(3):328-35. PMC: 3748601. DOI: 10.1038/ijo.2011.159. View

Aills L, Blankenship J, Buffington C, Furtado M, Parrott J . ASMBS Allied Health Nutritional Guidelines for the Surgical Weight Loss Patient. Surg Obes Relat Dis. 2008; 4(5 Suppl):S73-108. DOI: 10.1016/j.soard.2008.03.002. View

Papamargaritis D, Aasheim E, Sampson B, le Roux C . Copper, selenium and zinc levels after bariatric surgery in patients recommended to take multivitamin-mineral supplementation. J Trace Elem Med Biol. 2014; 31:167-72. DOI: 10.1016/j.jtemb.2014.09.005. View

Galloway P, McMillan D, Sattar N . Effect of the inflammatory response on trace element and vitamin status. Ann Clin Biochem. 2000; 37 ( Pt 3):289-97. DOI: 10.1258/0004563001899429. View

Parikh M, Eisenberg D, Johnson J, El-Chaar M . American Society for Metabolic and Bariatric Surgery review of the literature on one-anastomosis gastric bypass. Surg Obes Relat Dis. 2018; 14(8):1088-1092. DOI: 10.1016/j.soard.2018.04.017. View

Ben-Porat T, Elazary R, Goldenshluger A, Sherf Dagan S, Mintz Y, Weiss R . Nutritional deficiencies four years after laparoscopic sleeve gastrectomy-are supplements required for a lifetime?. Surg Obes Relat Dis. 2017; 13(7):1138-1144. DOI: 10.1016/j.soard.2017.02.021. View

OKane M, Parretti H, Pinkney J, Welbourn R, Hughes C, Mok J . British Obesity and Metabolic Surgery Society Guidelines on perioperative and postoperative biochemical monitoring and micronutrient replacement for patients undergoing bariatric surgery-2020 update. Obes Rev. 2020; 21(11):e13087. PMC: 7583474. DOI: 10.1111/obr.13087. View

Smelt H, Heusschen L, Theel W, van Rutte P, Nijboer T, Pouwels S . Factors Affecting Patient Adherence to Multivitamin Intake After Bariatric Surgery: a Multicentre Survey Study from the Patient's Perspective. Obes Surg. 2021; 31(10):4316-4326. PMC: 8310459. DOI: 10.1007/s11695-021-05571-y. View

Gletsu-Miller N, Wright B . Mineral malnutrition following bariatric surgery. Adv Nutr. 2013; 4(5):506-17. PMC: 3771134. DOI: 10.3945/an.113.004341. View

10.

Sjostrom L, Lindroos A, Peltonen M, Torgerson J, Bouchard C, Carlsson B . Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004; 351(26):2683-93. DOI: 10.1056/NEJMoa035622. View

11.

Parrott J, Frank L, Rabena R, Craggs-Dino L, Isom K, Greiman L . American Society for Metabolic and Bariatric Surgery Integrated Health Nutritional Guidelines for the Surgical Weight Loss Patient 2016 Update: Micronutrients. Surg Obes Relat Dis. 2017; 13(5):727-741. DOI: 10.1016/j.soard.2016.12.018. View

12.

Buchwald H, Avidor Y, Braunwald E, Jensen M, Pories W, Fahrbach K . Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004; 292(14):1724-37. DOI: 10.1001/jama.292.14.1724. View

13.

Cummings D, Arterburn D, Westbrook E, Kuzma J, Stewart S, Chan C . Gastric bypass surgery vs intensive lifestyle and medical intervention for type 2 diabetes: the CROSSROADS randomised controlled trial. Diabetologia. 2016; 59(5):945-53. PMC: 4826815. DOI: 10.1007/s00125-016-3903-x. View

14.

Robert M, Espalieu P, Pelascini E, Caiazzo R, Sterkers A, Khamphommala L . Efficacy and safety of one anastomosis gastric bypass versus Roux-en-Y gastric bypass for obesity (YOMEGA): a multicentre, randomised, open-label, non-inferiority trial. Lancet. 2019; 393(10178):1299-1309. DOI: 10.1016/S0140-6736(19)30475-1. View

15.

Mechanick J, Apovian C, Brethauer S, Garvey W, Joffe A, Kim J . CLINICAL PRACTICE GUIDELINES FOR THE PERIOPERATIVE NUTRITION, METABOLIC, AND NONSURGICAL SUPPORT OF PATIENTS UNDERGOING BARIATRIC PROCEDURES - 2019 UPDATE: COSPONSORED BY AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS/AMERICAN COLLEGE OF.... Endocr Pract. 2019; 25(12):1346-1359. DOI: 10.4158/GL-2019-0406. View

16.

Kumar P, Hamza N, Madhok B, De Alwis N, Sharma M, Miras A . Copper Deficiency after Gastric Bypass for Morbid Obesity: a Systematic Review. Obes Surg. 2016; 26(6):1335-42. DOI: 10.1007/s11695-016-2162-8. View

17.

Zarshenas N, Tapsell L, Batterham M, Neale E, Talbot M . Changes in Anthropometric Measures, Nutritional Indices and Gastrointestinal Symptoms Following One Anastomosis Gastric Bypass (OAGB) Compared with Roux-en-y Gastric Bypass (RYGB). Obes Surg. 2021; 31(6):2619-2631. PMC: 7901677. DOI: 10.1007/s11695-021-05284-2. View

18.

Mechanick J, Youdim A, Jones D, Garvey W, Hurley D, McMahon M . Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient--2013 update: cosponsored by American Association of Clinical Endocrinologists, the Obesity Society, and American.... Endocr Pract. 2013; 19(2):337-72. PMC: 4140628. DOI: 10.4158/EP12437.GL. View

19.

Kessler Y, Adelson D, Mardy-Tilbor L, Ben-Porat T, Szold A, Goitein D . Nutritional status following One Anastomosis Gastric Bypass. Clin Nutr. 2019; 39(2):599-605. DOI: 10.1016/j.clnu.2019.03.008. View

20.

Mahawar K, Bhasker A, Bindal V, Graham Y, Dudeja U, Lakdawala M . Zinc Deficiency after Gastric Bypass for Morbid Obesity: a Systematic Review. Obes Surg. 2016; 27(2):522-529. DOI: 10.1007/s11695-016-2474-8. View